A gentleman presents with shortness of breath and leg edema for 2 months that has become worse during the last 2 days. He has a history of diarrhea & protein wasting due to prior gastric bypass surgery, but is otherwise healthy. He denies fever, chest pain and cough.
On exam vitals are notable for tachypnea and tachycardia. Pulse ox is 95% on room air. The oropharynx is moist and his lungs are clear without wheezing or rales. His legs have 1-2+ bilateral edema with a negative Homan’s sign and no erythema.
EKG: atrial fibrillation at a rate of 158 and nonspecific ST abnormalities.
CBC: white count of 11, platelet count 137,000.
Chemistry: sodium 150, chloride 128, carbon dioxide 11, anion gap 11, creatinine 1.7, magnesium low at 1.2, albumin 1.7.
Troponin undetectable. BNP normal.
ABG on 2L O2: pH 7.36, pCO2 15, pO2 102.
Below is his chest x-ray. Click on cxr..
